cardiovascular system Flashcards
the hearts structure and function
Structures
Heart
Blood vessels
Main functions
Deliver oxygen and
nutrients to body cells
Remove waste products
Maintain perfusion to
organs and tissues
5 areas for listening to the heart
aortic, pulmonic, erbs point, tricuspid, mitral valve
pericardium
Outer protective layer
Fibrous sac that surrounds the heart
myocardium
Middle muscular layer
Thickest layer
Made up of contractile cells
endocardium
Inner smooth layer
sinoatrial node
initiates
electrical impulses
AV node
slows down impulses to the
ventricles
preload
volume of blood in the ventricles after diastole
after load
The afterload is the amount of pressure that the heart needs to exert to eject the blood during ventricular contraction.
jugular venous pressure
Reflects right atrial
pressure
When right atrial
pressure increases fluid
backs up in the lungs =
heart failure
When pressure is
increased it may result in
jugular vein distention
(JVD)
health history
Common or concerning symptoms
Chest pain or discomfort: chest pain is considered cardiac until proven
otherwise!
Pain or discomfort radiating to the neck, left shoulder or arm, and back
Arrhythmias: skipped beats, palpitations
Dyspnea
Cough
Edema
Nocturia-excessive urination at night
Fatigue
Cyanosis
Pallor
angina pectoris
chest pain
resulting from decreased blood flow
to the heart
palpitations
Heart skipping, racing, fluttering
paroxysmal nocturnal dyspnea
Paroxysmal nocturnal dyspnea-
severe onset SOB or coughing while
sleeping. May awaken suddenly.
dyspnea and orthopnea
Dyspnea- difficulty breathing
Orthopnea- difficulty breathing
when lying flat
symptoms of heart failure
Cough
May signal heart failure
Coughing pink,
frothy sputum =
heart failure
Edema in feet or
ankles = heart
failure
Edema
Does it clear at night
when patient puts feet
up?
Fatigue
May signal heart is not
adequately supplying
oxygen
Cyanosis or pallor
Poor oxygenation of
body
what would you ask a cardiac patient
What do we want to ask our patient about past
history?
Heart problems or previous heart disease?
Murmurs?
Congenital heart disease/defect – can affect
ability of the heart to pump
Rheumatic fever? (caused by Strep A – can
damage heart valves)
Hypertension? (most important risk factor
contributing to heart disease)
Elevated cholesterol or triglycerides – both
can contribute coronary artery disease
(CAD)
Diabetes?
family history
What do we want to ask the
patient about family history?
Coronary artery disease?
Hypertension?
Sudden death younger than
60?
Stroke?
Diabetes?
Obesity?
lifestyle habits
What do we want to ask the
patient about lifestyle habits?
Nutrition / diet
Smoking
Alcohol
Exercise
physical exam
Comfortable and calm
Explain procedure
Examination gown (opened
in the front)
Assist to examining table
Cover with drape
Perform examination from
patient’s right side
May need patient to change
positions
general impression
General Impression
Affect: anxiety may occur
with MI
Color: cyanosis, pallor
Temperature: cool, moist -
concerning
neck vessels
Inspection
Observe the neck for distended jugular veins
The jugular vein should not be distended or bulging with the patient sitting at 45 degrees or greater
Distention may indicate right-sided heart failure
If distention is noted place the patient at 45, 60 and 90 degrees and assess for distention
Document at which positions you observe distention
Auscultation
Using the bell of the stethoscope listen over the carotid artery and direct patient to hold their breath.
A swishing or blowing sound may indicate a narrowing vessel = bruit
If a bruit is audible, consider not palpating the carotid artery or GENTLY palpate
Always auscultate carotid arteries prior to palpation! Palpation may change the heart rate and impulse.
apical impulse
If the apical pulse is larger than 1-
2cm = suspect cardiac enlargement
May not be palpable in larger
clients
Should be the size of a nickel if
palpable
auscultation of the heart
Positioning patient
Supine
Turning to left side –
brings heart forward to
better hear apical
Sitting and leaning
forward- may reveal extra
heart sounds or murmur
Inspection
Apical pulse – may be
visible
Palpation
Auscultation- regular rate
and rhythm?
assessing the carotid pulse
Weak = low cardiac output, hypovolemia
Inequality of pulses = arterial occlusion
0 = absent 1+ = Weak – easy
to obliterate 2+ = normal 3+ = Bounding –
unable to obliterate
Never palpate right and left carotid arteries simultaneously
Note rate, rhythm and amplitude (strength)
Place your index and middle fingers on the right then the left
carotid arteries, and palpate the carotid pulse
Keep the patient’s head elevated to 30°
If the apical pulse is larger than 1-
2cm = suspect cardiac enlargement
May not be palpable in larger
clients
Should be the size of a nickel if
palpable
Bounding = high cardiac output, hypervolemia
apical impulse
If the apical pulse is larger than 1-
2cm = suspect cardiac enlargement
May not be palpable in larger
clients
Should be the size of a nickel if
palpable
auscultation of the heart
Positioning patient
Supine
Turning to left side –
brings heart forward to
better hear apical
Sitting and leaning
forward- may reveal extra
heart sounds or murmur
Inspection
Apical pulse – may be
visible
Palpation
Auscultation- regular rate
and rhythm?
lub - dub
normal heart sounds caused by closing of the valves
lub
recoil of blood against av closed valves
systole
dub
recoil of blood against closed semilunar valves
diastole
the cardiac cycle
The cardiac cycle
Systole: period of
ventricular contraction
Diastole: period of
ventricular relaxation
heart murmurs
MURMUR
S
Abnormal, turbulent blood flow which
creates a swooshing sound
Increased blood volume (in
pregnancy)
Structural valve defects – may be
congenital
Abnormal chamber openings
Can be benign or serious
Use the diaphragm and bell of the
stethoscope to listen for murmurs.
Assess the patient supine, left lateral
and sitting leaning forward. This
change the position of the heart
increasing the likelihood of hearing the
murmur.
causes of heart disease
diabetes, smoking, gender (males), lifestyle, genetics, ageing, diet
signs of coronary artery disease and MI
in men:
discomfort in back, neck, jaw, tingling in the limbs, chest pain, shortness of breath,
women:
sudden dizziness, nausea vomiting, unusual tiredness, heartburn like feeling,
changes in the body during pregnancy
vasodilation, decrease in vasoconstriction, increased sympathetic activity, increased heart rate, plasma volume expansion, total blood volume increase, increased cardiac output, left ventricular mass increases, chambers dilate
child and infant considerations
At birth, lung aeration causes circulatory changes
This is because in the womb, the fetus’s blood is shunted through the foramen ovale and ductus arteriosus into the left side of the heart and out the aorta, bypassing the lungs
The foramen ovale closes.
Murmurs are commonly heard in the newborn and throughout childhood
The heart should be auscultated at approximately the fourth intercostal margin to the left of the Mid clavicular line
Until the age of 7 where it moves to the 5th ICS
newborn and infant heart rate
For a newborn, the HR should be 120–160 beats/min.
At 6 months, rate is approximately 120 beats/min.
At 6 months to 1 year, rate is approximately 110 beats/min
aging adult
The most common aging change is increased stiffness of the
large arteries, called arteriosclerosis
Blood pressure increases as elasticity decreases in arteries with
proportionately greater increase in systolic pressure
An older adult’s baroreceptor response to positional changes is
slightly less efficient and a slight decrease in blood pressure may
occur.
Orthostatic hypotension occurs when blood pressure falls upon
standing.
Increasing the risk of FALLS
The chambers of the heart may increase in size.
arteries
Carry oxygenated, nutrient-
rich blood from the heart to
the capillaries
Major arteries of arm:
brachial, radial, ulnar
Major arteries of the leg:
femoral, popliteal, dorsalis
pedis, posterior tibial
veins
Carry deoxygenated, nutrient
-depleted, waste-laden blood
from the tissues back to the
heart
Three types of veins: deep
veins, superficial veins, and
perforator veins
Femoral, popliteal,
saphenous veins
lymphatic system
Lymphatic capillaries, lymphatic vessels, lymph nodes
Capillaries and fluid exchange
Small blood vessels
Form the connection between the arterioles and venules
Allow the circulatory system to maintain vital equilibrium
peripheral arterial disease
top of toes, top of feet, lateral ankle region
pale to pink ulcers, no granulation, or necrotic tissue, round punched out appearance
peripheral venous disease
medial parts of the lower legs and ankles,
ulcers with swollen edges, granulation is present, deep red to pink, edges irregular and shallow
risk factors for venous stasis
Long periods of standing still, sitting, or lying down.
Lack of muscular activity causes blood to pool in the legs,
which, in turn, increases pressure in the veins.
Varicose (tortuous and dilated) veins, which increase
venous pressure. Damage to the vein wall can also
contribute to venous stasis.
reduce risk factors associated pvd
Quit smoking if you’re a smoker.
If you have diabetes, keep your blood sugar under control.
Exercise regularly. Aim for 30 minutes at least three times a week
after you’ve gotten your doctor’s OK.
Lower your cholesterol and blood pressure levels, if necessary.
Eat foods that are low in saturated fat.
Maintain a healthy weight.
current symptoms
Skin changes
Leg pain, heaviness, or aching
Leg veins
Leg sores or open wounds
Swelling in legs or feet
Men: sexual activity changes
Swollen glands or nodules
subjective data history
Past
Previous problems with circulation in arms or legs
Heart or blood vessel surgeries or treatments
Family
Varicose veins, diabetes, hypertension, coronary heart disease, or elevated
cholesterol or triglyceride levels
lifestyle and health practices
Tobacco use
Regular exercise
Oral contraceptives use
Degree of stress
Peripheral vascular problems interfering with ADLs
Medications to improve circulation or control blood pressure
Support hose
arms palpation and inspection
Fingers, hands, and arms for
temperature
Capillary refill time
Radial, ulnar, and brachial
pulses
Epitrochlear lymph nodes
Allen test
legs inspection and palpation
Skin color
Distribution of hair
Lesions or ulcers
Edema
Temperature
Superficial inguinal lymph nodes
Femoral pulse, listening for bruits
Popliteal, dorsalis pedis, posterior tibial pulses
Inspect for
varicosities and
thrombophlebitis
by asking client to
stand:
Homans sign
pregnancy considerations
With the dynamic increase in maternal blood volume, a
physiologic anemia commonly develops.
Progesterone acts on the vessels to make them relax and dilate.
Dizziness and lightheadedness are common
Increased edema and varicosities
Varicose veins in the lower extremities, vulva, and rectum are
common
More prone to development of thrombophlebitis
older adult considerations
Hair loss on the lower extremities occurs with aging and is,
therefore, not an absolute sign of arterial insufficiency in the older
client.
With aging, lymphatic tissue is lost, resulting in smaller and fewer
lymph nodes.
Varicosities are common in the older client.
A bruit is abnormal because of the high risk of CVA from a carotid
embolism, abdominal or femoral aneurysm.
S3 heart sound
S3 (Third Heart Sound)
Also called a ventricular gallop, the S3 has a low frequency and is heard best using the bell of the stethoscope at the apical area or lower right ventricular area of the chest with the client in the left lateral position. The sound is often accentuated during inspiration and has the rhythm of the word “Ken-tuc-ky.” S3 is the result of vibrations caused by the blood hitting the ventricular wall during rapid ventricular filling.
The S3 can be a normal finding in young children, people with a high CO, and in the third trimester of pregnancy. It is rarely normal in people older than 40 years and is usually associated with decreased myocardial contractility, myocardial failure, congestive heart failure, and volume overload of the ventricle from valvular disease.
S4
S4 (Fourth Heart Sound)
Also called an atrial gallop, S4 is a low-frequency sound occurring at the end of diastole when the atria contract. It is caused by vibrations from blood flowing rapidly into the ventricles after atrial contraction. S4 has the rhythm of the word “Ten-nes-see” and may increase during inspiration. It is best heard with the bell of the stethoscope over the apical area with the client in a supine or left lateral position, and is never heard in the absence of atrial contraction.
The S4 can be a normal sound in trained athletes and some older clients, especially after exercise. However, it is usually an abnormal finding and is associated with coronary artery disease, hypertension, aortic and pulmonic stenosis, and acute MI.
pericardial friction rub
Pericardial Friction Rub
Usually heard best in the third ICS to the left of the sternum, a pericardial friction rub is caused by inflammation of the pericardial sac. A high-pitched, scratchy, scraping sound, the rub may increase with exhalation and when the client leans forward. For best results, use the diaphragm of the stethoscope and have the client sit up, lean forward, exhale, and hold their breath.
The pericardial friction rub can have up to three components: atrial systole, ventricular systole, and ventricular diastole. These components are associated with cardiac movement. The first two components are usually present. If only one component is present, the rub may be confused with a murmur. Friction rubs are commonly heard during the first week after an MI. If a significant pericardial effusion is present, S1 and S2 sounds will be distant.
innocent murmur
Innocent Murmur
Not associated with any physical abnormality, innocent murmurs occur when the ejection of blood into the aorta is turbulent. Very common in children and young adults, they may also be heard in older people with no evidence of cardiovascular disease. A client may have an innocent murmur and another kind of murmur.
physiologic murmur
Physiologic Murmur
Caused by a temporary increase in blood flow, a physiologic murmur can occur with anemia, pregnancy, fever, and hyperthyroidism.
